Neobook — clinical reference

Feeding

When to Return

Follow-up Visits

Support the Family to Care for the Child

Counsel the Caregiver

Give Additional Counselling

1. Feeding

Counsel the mother to feed her child based on the child’s age and findings of feeding assessment

2. When to Return

Advise caregiver to return immediately if the child has any of these signs
Any sick child	Becomes sicker Not able to drink or breastfeed Has convulsions Vomiting everything Develops a fever Develops oedema
If child has COUGH OR COLD, also return if	Fast breathing Difficult breathing Wheezing
If child has DIARRHOEA, also return ifS	Blood in stool Drinking poorly

Routine well child visit advice
caregiver when to return for next Routine Child visit

Follow-Up Visit: Advise Caregiver to Come for Follow-Up at the Earliest Time Listed

If the child has	Return for follow-up in
Pneumonia Dysentery Some dehydration - if diarrhoea not improving Malaria - if fever persists Suspected malaria - if fever persists Fever - Other cause - if fever persists Measles Suspected measles	2 days
Cough or cold - if no improvement Wheeze - First episode - if still wheezing No visible dehydration - if diarrhoea not improving Persistent diarrhoea Acute ear infection - if pain / discharge persists Possible streptococcal infection - if symptoms persist Feeding problems	5 days
Severe acute malnutrition with no medical complication Moderate acute malnutrition Feeding problem High risk of TB or risk of TB	7 days
Acute or chronic ear infection Anaemia Not growing well - but no feeding problem	14 days
HIV-infection Ongoing HIV exposure Suspected symptomatic HIV HIV exposed TB exposed Confirmed or probable TB Overweight/ Obese	Monthly

3. Support the Family to Care for the Child

Help the mother, family and caregiver to ensure the child’s needs are met.
Assess any needs of the family and provide or refer for management

4. Counsel the Caregiver About Her Own Health

If the caregiver is sick, provide care for her, or refer her for help
Advise the caregiver to eat well to keep up his/ her own strength and health
Encourage caregiver to grow local foods, if possible, and to eat fresh fruit and vegetables
Ensure that the child’s birth is registered
Where indicated, encourage the caregiver to seek social support services e.g. Child Support Grant

Make sure the caregiver has access to:
- Contraception and sexual health services, including HIV testing services
- If mother is HIV negative: retest at the 10 week postnatal visit, 6 month visit and every 3 months while breastfeeding
- Counselling on STI and prevention of HIV-infection
- Any other health or social services she requires

5. Give Additional Counselling if the Mother or Caregiver is HIV-positive

Encourage disclosure: disclosure may improve adherence and viral suppression which is important for all caregivers, including breastfeeding mothers
If mother is not on ART: offer same-day ART initiation
If mother is on ART: check the mother’s VL and if suppressed repeat VL every 6 months while breastfeeding. If not virally suppressed: follow the VL non-suppression algorithm in national ART guidelines
Emphasise the importance of adherence if on ART
Emphasise early treatment of illnesses, opportunistic infections or drug reaction
Counsel caregiver on eating healthy foods that include protein, fat, carbohydrate, vitamins and minerals
Reassure her that with regular follow-up, much can be done to prevent serious illness, and maintain her and the child’s health

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Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Counsel the Caregiver; Advise Caregiver to Give Home Care

Last checked for updates: June 2023